ObjectivesTo systematically review the evidence regarding the efficacy of vaccines or immunostimulants in reducing the recurrence rate of urinary tract infections (UTIs). Materials and MethodsThe Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), PubMed, Cochrane Library, World Health Organization (WHO) International Clinical Trials Registry Platform Search Portal, and conference abstracts were searched up to January 2018 for English-titled citations. Randomised placebo-controlled trials evaluating UTI recurrence rates in adult patients with recurrent UTIs treated with a vaccine were selected by two independent reviewers according to the Population, Interventions, Comparators, and Outcomes (PICO) criteria. Differences in recurrence rates in study populations for individual trials were calculated and pooled, and risk ratios (RRs) using random effects models were calculated. Risk of bias was assessed using the Cochrane Collaboration's tool and heterogeneity was assessed using chi-squared and I 2 testing. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence (QOE) and summarise findings. ResultsIn all, 599 records were identified, of which 10 studies were included. A total of 1537 patients were recruited and analysed, on whom data were presented. Three candidate vaccines were studied: Uro-Vaxom â (OM Pharma, Myerlin, Switzerland), Urovac â (Solco Basel Ltd, Basel, Switzerland), and ExPEC4V (GlycoVaxyn AG, Schlieren, Switzerland). At trial endpoint, the use of vaccines appeared to reduce UTI recurrence compared to placebo (RR 0.74, 95% confidence interval [CI] 0.67-0.81; low QOE). Uro-Vaxom showed the greatest reduction in UTI recurrence rate; the maximal effect was seen at 3 months compared with 6 months after initial treatment (RR 0.67, 95% CI 0.57-0.78; and RR 0.78, 95% CI 0.69-0.88, respectively; low QOE). Urovac may also reduce risk of UTI recurrence (RR 0.75, 95% CI 0.63-0.89; low QOE). ExPEC4V does not appear to reduce UTI recurrence compared to placebo at study endpoint (RR 0.82, 95% CI 0.62-1.10; low QOE). Substantial heterogeneity was observed across the included studies (chi-squared = 54.58; P < 0.001, I 2 = 84%). ConclusionsWhile there is evidence for the efficacy of vaccines in patients with recurrent UTIs, significant heterogeneity amongst these studies renders interpretation and recommendation for routine clinical use difficult at present. Further randomised trials using consistent definitions and endpoints are needed to study the long-term efficacy and safety of vaccines for infection prevention in patients with recurrent UTIs.

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Objective To report our experience with metallic self-quality of life was improved and symptoms such as loin pain were ameliorated. Renal function was pre-expanding stents in the palliative care of patients with ureteric obstruction caused by advanced pelvic served; the mean serum creatinine level before and after stenting was 636 and 263 mmol/L, respectively). malignancy. Patients and methods Seven patients (five men and twoThe mean duration of stent patency was 9 months. Of the five patients who subsequently died, only two women, mean age 72.8 years, range 58-88) with ureteric obstruction caused by advanced pelvic malig-had recurrent renal failure, presumably caused by stent occlusion. nancy were evaluated. Self-expanding metallic Memotherm@ stents (Angiomed, Karlsruhe, Conclusions The use of metallic stents in the palliative care of ureteric obstruction caused by advanced pelvic Germany) were deployed using an antegrade approach in all patients. Patients were followed for a mean malignancy is a safe and eCective treatment. Keywords Metallic stent, ureteric obstruction, palliation, (range) of 9 (4-13) months to assess renal function and survival. pelvic malignancy Results All seven patients had good palliation; their or intrinsic) influence the patency of the stent, e.g. the

The results of 10 years' experience of treating pelviureteric junction (PUJ) obstruction by balloon dilatation are reviewed, and recommendations about the suitability of the technique for individual patients are made based on the patient's history and a preoperative DTPA renogram. Of 76 patients, 32 (42%) had no further symptoms after balloon dilatation. Six (8% continued to have mild loin pain only. In 33 patients (43%), there was no improvement in symptoms, split renal function, or drainage. Of this group, 21 patients (28%) underwent repeat balloon dilatation. Nine (12% became asymptomatic, and a further four (5%) had only minimal residual symptoms. The overall success rate of the procedure in terms of symptomatic abolition or improvement thus was 67%. Patients with < 25% function in the affected kidney preoperatively or who had undergone a previous pyeloplasty were the most likely to require additional treatment. No deaths were recorded, and morbidity was minimal.